I stumbled upon International Medical Aid’s website while looking for an opportunity to gain experience in the healthcare field. This program stood out to me because the internship was unique in providing insight to specific health care roles. As a Pre-PA student, my experience up to this point was limited to working as a nursing assistant in a brain injury rehab and in an emergency room. Although these experiences were valuable in forming the foundation for my career goals, there was a whole other side of healthcare that I had yet to see. I was curious to learn more about how healthcare in other countries differed from that of the USA. Out of curiosity, I decided to apply for International Medical Aid’s pre-pa internship. After a few months, I received the news that I was accepted. I was terrified, but excited at the same time. I had never traveled alone, but I needed to push past my comfort zone and learn more about the world outside of my two-story suburban home. Without hesitation, I booked my ticket and flew to Mombasa, Kenya.
To my surprise, Mombasa was very similar to my motherland, India. I felt at home as we passed by colorful buildings and street vendors. When I was given a tour of Coast Provincial General Hospital for the first time, I was shocked at how different the hospital was from a typical American hospital. One of the first places we visited was the NICU. The incubators were filled with up to four babies, and the staff was extremely limited. There were two to three nurses in charge of over fifty babies! I learned that the nurses depended on the mothers to tend to their children because there is not enough staff to watch over all of the infants. I could only imagine what I would see next. I was placed in surgery the first week and shadowed Dr. Hasan. We went patient to patient, and I saw cases that I had never seen in America. During our disease burden lecture, we learned that the most common cases that you will see in a Kenyan Hospital are “malaria, respiratory diseases, skin diseases, diarrhea, and accidents” (Disease Burden Lecture, n.d). Patients are at a higher risk of acquiring these illnesses because of their environment and living conditions. Dr. Hasan emphasized how important it was to touch the patient instead of solely relying on scans and verbal complaints. I admired how the team of surgeons worked tirelessly to assess and treat each patient in an overcrowded ward with no air conditioning. When I asked Dr. Hasan why he chose to work in a public hospital instead of a private hospital, he explained that these patients were in dire need of medical attention, and it was important for him to serve the needs of the public community, especially those with low-incomes. “Public hospitals have the most accessible and affordable care for populations, but they are also the most under-resourced and have higher rates of poor patient outcomes” (International Medical Aid, n.d).
While in the OR, I noticed there was no proper protocol to enforce scrubbing in and scrubbing out, and staff walked freely from room to room. When radiation was involved, I was told to stand behind staff with protective garments on because there were not enough gowns for everyone. I met a kind nurse who was able to take the time to explain each surgery to me. I learned that a common issue that they have in the OR was lack of equipment. If a surgeon needed a specific tool and it was not available, they would have to make do with what they had on the table. One surgery that stuck out to me was an anterior cervical discectomy and fusion performed by a group of surgeons from Spain. They treated a patient’s spinal cord compression by decompressing the spinal cord and nerve roots of the cervical spine. Then, they performed an inter-vertebral fusion to stabilize the corresponding vertebrae. Their team and the medical staff at Coast General had to work together to overcome the language barrier in order to execute the surgery. Overall, I was extremely grateful to have my first rotation in surgery. I learned that there was a vast difference in protocol between our two countries, and this is largely due to differences in access to equipment and proper staffing.
My second rotation was in the emergency room. The first thing I noticed in the ER was that the doctors were in charge of inserting IVs, and that it consumes a lot of their time. In America, nurses are trained to place IVs so that the doctors can focus their time on meeting the patient’s medical needs. One doctor that I shadowed had trouble inserting an IV in an infant who came in in critical condition. The infant eventually passed because she was not able to get the medication and fluids that she needed fast enough. This was not the first death I had seen from a patient seeking medical attention at late stages. I learned that many low-income patients in Kenya hesitate to make their health a priority because they have to weigh the cost of travel, missing work, and health care expenses. Additionally, health literacy continues to be a massive issue in under-served populations. Patients fail to assume an active role in preserving their health because they are simply unaware of their options.
One thing I discovered in the ER is that the billing and administration process is extremely frustrating. Doctors completely rely on the patients to maintain their medical history in a small booklet. To administer medication, a doctor will issue a prescription. The patient’s family will then have to visit the pharmacy and billing and then show proof of payment before the doctor can even administer the medication. There was one instance with a patient’s family that I will always remember. A pediatric patient had passed, and his family was taken out of the ER. The grandfather came back and wandered aimlessly trying to find someone to assist him. This poor man had just lost his only grandchild, and he was desperately trying to pay the bill so he could leave and be with his family.
Also, the lack of equipment, staff, and space is glaringly apparent. “The doctor to patient ratio per 1,000 people is 1:5000” (International Medical Aid, n.d). Most health care workers in Kenya choose to work in private sectors, or work in public sectors temporarily and then move to private as a result of burn-out. Public hospitals are under-resourced, under-staffed, and have higher rates of stress while confronting the obstacles they face. I remember standing between a Masai warrior with a neck injury and an HIV patient that was going to die because they did not have enough ICU beds. I assisted the doctor in creating a makeshift c-spine collar for the neck injury patient out of a cardboard box and cloth. We wrapped it around the patient’s neck and used tape to hold it together. I could not believe the ER doctors had to go to this length to make up for the conditions that they worked in. I admired their ability to assess a situation quickly and get creative in finding a solution.
After interning at Coast Provincial General Hospital, I have developed a deeper understanding of my desired role as a future health care provider. I knew that I wanted to be a Physician Assistant, but I didn’t put much thought into where I would work and what I would do after I achieved this goal. Through International Medical Aid, I realized that my education would have a meaningful impact on communities that cannot access the care they need. I was able to gain so much knowledge and perspective on the accessibility of healthcare. I have decided to work as a primary care provider in underserved communities. My dream is to provide care for those who need it the most, but do not have the means to attain it. As a future Physician Assistant, I will do all I can to increase access to health care services in medically under-served populations.
I am so glad that I took the leap and applied for International Medical Aid. I was able to immerse myself in Kenyan culture and gain perspective on what health care is like there. The staff went above and beyond to make sure we felt comfortable and safe. They were extremely flexible and worked with us to adjust any last-minute changes. After interning with International Medical Aid, I have developed a deeper understanding of my desired role as a future health care provider.